scholarly journals Peripheral Nerve Pulsed Radiofrequency For Trigeminal Neuralgia Treatment: Is It An Effective Method?

2021 ◽  
Author(s):  
Tuba Tanyel ◽  
Ayten Bilir ◽  
Sacit Gulec
Keyword(s):  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Trigeminal Nerve ◽  
Treatment Options ◽  
Percutaneous Technique ◽  
Pulsed Radiofrequency ◽  
Safe Method ◽  
Duration Of Efficacy ◽  
Effect Duration

Abstract ObjectiveTrigeminal neuralgia is a paroxysmal and shock-like pain in the trigeminal nerve area. Various treatment options have been used for trigeminal neuralgia such as medical treatment, interventional procedures and surgical operations. Pulsed radiofrequency (PRF) is a minimally invasive percutaneous technique which seems to be safer and easier to perform.This retrospective study aims to evaluate the analgesic effect, duration of efficacy and side effects of PRF procedures in the peripheral branches of the trigeminal nerve.Methods and MaterialThe data of the patients with trigeminal neuralgia who were followed up in our hospital's algology clinic from 2016 to 2018 were reviewed retrospectively. Patients aged between 18-70 who didn’t respond to medical treatment or couldn’t use medication due to side effects, were treated with PRF procedure for peripheral branches of trigeminal nerve were selected for this study. Demographic profile, clicinal presentation, pain intensity, duration of efficacy and complications were evaluated from their files.Results21 patients who underwent ultrasonography (USG) guided PRF procedures were included the study.Mean visual analog scale (VAS) value of the patients was found to have decreased from 9.25 ± 0.63 to 1.55 ± 0.88 at the end of the first month (p<0.001). The painless period for the patients lasted up to 12 (9-21) months and no complications occurred.ConclusionPRF procedure seems to be an effective and safe method in patients who respond to block of the peripheral branches of the trigeminal nerve.Key message: The use of pulsed radiofrequency method for the treatment of trigeminal neuralgia seems to be an effective and safe method. In addition, being easily applicable and repeatable is another advantage of the method.

Anatomoradiological Landmarks for Accuracy of Radiofrequency Thermorhizotomy in the Treatment of Trigeminal Neuralgia

2008 ◽  
Vol 63 (suppl_1) ◽  
pp. ONS129-ONS138 ◽  
Author(s):  
Mehmet Tatli ◽  
Marc Sindou
Keyword(s):  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Study Groups ◽  
X Rays ◽  
Preoperative Pain ◽  
Paired Samples ◽  
Percutaneous Procedures ◽  
Trigeminal Root ◽  
Mean Differences

Abstract Objective: The correct positioning of the electrode is of prime importance for effectiveness and selectivity of percutaneous trigeminal radiofrequency thermorhizotomy (RF-TR) for the treatment of trigeminal neuralgia (TN). The aim of our study was to establish some anatomoradiological landmarks for the purpose of accurate placement of the electrode tip in RF-TR. Methods: Of 1000 patients who underwent RF-TR, 100 were retrospective and randomly selected and divided into study groups according to postoperative hypoesthesia in the trigeminal nerve divisions. The patients’ petroclival angle, petroelectrodal angle, electrode tip, and the petroelectrodal angle/petroclival angle ratio were calculated on lateral cranial x-rays. These measurements were then correlated with the topography of hypoesthesia obtained by the RF-TR to define the anatomoradiological x-ray landmarks corresponding to the divisions of the trigeminal root. The postoperative hypoesthesia groups were correlated with their respective preoperative pain topography to check the accuracy of the thermolesion. In addition, the intraoperatively evoked paresthesia responses and the side effects were evaluated. The results were analyzed using a paired-samples Student's ttest, the χ2 test, and one-way analysis of variance, followed by Bonferroni and Tamhane post hoc tests. Results: All study groups were comparable with respect to age, sex, side effects, electrode tip location, side of TN, and values of petroclival angle. The lowest values of petroelectrodal angle/orbitomeatal electrodal angle and petroelectrodal angle/ petroclival angle were detected in patients with V3 TN, whereas the greatest values were in patients who had TN in all branches of the trigeminal nerve. The greatest height of the electrode was in patients who had TN in all branches, whereas the least height was in patients with V3TN. When the results were compared with each other, the mean differences were found to be statistically significant between V3 TN patients and the other groups with different Pvalues. There was no statistical difference between the postoperative hypoesthesia data and the preoperative pain topography, which demonstrated evidence of the accuracy of the thermolesion in our series. Conclusion: Our data suggest that the determination of the presented landmarks allows customization to individual patient anatomy and may help the surgeon achieve a more selective effect with a variety of percutaneous procedures for each branch of the trigeminal root.

scholarly journals Trigeminal Neuralgia

2021 ◽  
pp. 531-546
Author(s):  
Kandasamy Ganesan ◽  
Asha Thomson
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Treatment Options ◽  
Gamma Knife Radiosurgery ◽  
Clinical History ◽  
Sensory Innervation ◽  
Root Entry Zone ◽  
Course Of Action ◽  
Set Up ◽  
Self Help Groups

AbstractNeuralgia can be defined as paroxysmal, intense intermittent pain that is usually confined to specific nerve branches to the head and neck. The trigeminal nerve is responsible for sensory innervation of the scalp, face and mouth, and damage or disease to this nerve may result in sensory loss, pain or both. >85% of cases of Trigeminal Neuralgia are of the classic type known as Classical Trigeminal Neuralgia (CTN), while the remaining cases can be separated to secondary Trigeminal Neuralgia (STN). STN is thought to be initiated by multiple sclerosis or a space-occupying lesion affecting the trigeminal nerve, whereas the leading cause of CTN is known to be compression of the trigeminal nerve in the region of the dorsal root entry zone by a blood vessel. There is no guaranteed cure for the condition of Trigeminal Neuralgia, but there are several treatment options that can give relief. In this chapter, we review the common neuralgias occurring within the oral and maxillofacial region with special emphasis on Trigeminal Neuralgia. We will discuss the historical evolution of treatment including the medical and surgical modalities with the use of current literature and newer developments. It has been highlighted that the first line of treatment for trigeminal neuralgia is still pharmacological treatment, with Carbamazepine and Oxcarbazepine being the first choice. Possible surgical methods of treatment are discussed within this chapter including modalities such as Microvascular Decompression, Gamma Knife Radiosurgery and Peripheral Neurectomy. As an OMF surgeon, it is important to obtain a good clinical history to rule out other pathology including dental focus. Many clinicians involved ranging from primary care dentists and doctors to secondary care (neurologists, Oral Medicine, OMFS, etc.) to deliver the appropriate first course of action, which is the medical management. The management of TN patients should be carried out in a multidisciplinary setting to allow the patients to choose the best-suited option for them. It is also important to set up self-help groups to enable them to share knowledge and information for themselves and their family members for the best possible outcomes.

scholarly journals Microvascular Decompression for Trigeminal Neuralgia: Our Experiences at Bir Hospital

2017 ◽  
Vol 14 (2) ◽  
pp. 3-7
Author(s):  
Gopal R Sharma ◽  
Rajiv Jha ◽  
Prakash Poudel ◽  
Dhrub R Adhikari ◽  
Prakash Bista
Keyword(s):  
Pain Relief ◽  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Treatment Options ◽  
Superior Cerebellar Artery ◽  
Anterior Inferior Cerebellar Artery ◽  
Recurrent Pain ◽  
Cerebellar Artery

Trigeminal neuralgia (TGN) is a very peculiar disease, mostly characterized by unilateral paroxysmal facial pain, often described by patient as ‘one of the worst pain in my life’. This condition is also known as ‘Tic Douloureus’. The annual incidence of TN is about 4.7/100000 population, male and female are equally affected. The diagnosis is usually made by history, clinical fi ndings and cranial imaging is required to rule out compressing vascular loop, organic lesions and Multiple Sclerosis (MS) at Trigeminal nerve (TN). Treatment of TGN ranged from medical to surgical intervention. Between September 2007 and April 2015, 20 patients underwent micro vascular decompression (MVD) of TN for TGN who were refractory to medical treatment at department of Neurosurgery, Bir Hospital. All decompressions were performed using operating microscope. Follow up period ranged from 22 months to 8 years.There were 9 males and 11 females and age ranged from 30-70 years. The neuralgic pain was localized on right side in 13 patients and left on 7 patients. Pain distribution was on V3 (mandibular branch) dermatome in 11, V2( Maxillary branch ) in 4, V2-3 in 2 and V1- 2-3 in 3 patients respectively. On intraoperative fi ndings TN was compressed by superior cerebellar artery ( SCA ) in 8, tumors in 4, unidentifi ed vessels in 3, veins in 2, anterior inferior cerebellar artery ( AICA ) in 1 and no cause was found in 2 patients. 7 patients suffered postoperative complications which included hyposthesia in 3, pseudomeningocele in 3 and meningitis in 1. There was no mortality in this series. 20 patients felt pain relief immediately after procedure and 1 patients came after 3 years with recurrent pain requiring second surgery. In conclusion, MVD for TGN in younger patients who are refractory to medical treatment is one of the best treatment options which is safe and long term pain relief is achieved in majority of cases.Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page:11-15

scholarly journals Refractory cluster-tic syndrome: The Hickam’s dictum

2021 ◽  
Vol 2 (4) ◽  
Author(s):  
Membrilla JA ◽  
◽  
Díaz de Terán J ◽  
Keyword(s):  
Magnetic Resonance ◽  
Trigeminal Neuralgia ◽  
Cluster Headache ◽  
Medical Treatment ◽  
Trigeminal Nerve ◽  
Microvascular Decompression ◽  
Neurovascular Conflict ◽  
Surgical Exploration ◽  
Keywords Trigeminal Neuralgia ◽  
The Right

A 50-year-old man debuted with right trigeminal neuralgia. In the following years, it became refractory to medical treatment and ipsilateral cluster headache appeared. He was diagnosed with cluster-tic syndrome. A brain magnetic resonance with high-spatialresolution 3D T2 sequences (FIESTA) excluded the existence of neurovascular conflict, but a surgical exploration was indicated due to its torpid evolution. A venous contact with the right trigeminal nerve was confirmed in the surgery and microvascular decompression was performed. The patient’s evolution was favorable, improving the trigeminal neuralgia as well as the cluster headache. Keywords: Trigeminal neuralgia; cluster headache; cluster-tic syndrome; microvascular decompression.

scholarly journals Trigeminal Neuralgy

2018 ◽  
Vol 1 (4) ◽  
pp. 353-358
Author(s):  
Bélgica Vásquez
Keyword(s):  
Surgical Treatment ◽  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Facial Pain ◽  
Relevant Information ◽  
Detailed Knowledge ◽  
Neurovascular Compression ◽  
Present Information ◽  
Facial Area

The objective of this review was to present information on the main causes, possible treatments and morpho-quantitative aspects of trigeminal neuralgia. Trigeminal neuralgia is a condition characterized by intense facial pain, severe throbbing or stabbing; it is usually unilateral and recurrent and is located in the facial area innervated by the trigeminal nerve. The causes of this disease are varied and include neurovascular compression stresses. Medical treatment of choice is carbamazepine, reserving surgical treatment for cases resistant to medical therapy or cases when side effects of drugs used, outweigh the risks and disadvantages of surgery. In this context a detailed knowledge of the structure of the trigeminal nerve and its morphoquantitative characteristics could provide relevant information to make type of treatment more effective.

Improved Outcome in the Treatment of Trigeminal Neuralgia by Percutaneous Stereotactic Rhizotomy with a New, Curved Tip Electrode

Neurosurgery ◽  
1983 ◽  
Vol 12 (3) ◽  
pp. 313-317 ◽  
Author(s):  
William D. Tobler ◽  
John M. Tew ◽  
Eric Cosman ◽  
Jeffrey T. Keller ◽  
Barbara Quallen
Keyword(s):  
Side Effects ◽  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Electrode Placement ◽  
Improve Treatment ◽  
Infinite Variety ◽  
Motor Root ◽  
Improved Outcome

Abstract Percutaneous stereotactic rhizotomy (PSR) as a method of treatment of trigeminal neuralgia has gained popularity in recent years as techniques of electrode placement and lesion production have improved. However, undesirable side effects including major and minor paresthesias, trigeminal motor root weakness, diplopia, and keratitis continue to occur even in cases where the neuralgia is treated successfully. In an attempt to improve treatment further, we have developed an electrode with a flexible curved tip for PSR of the trigeminal nerve. Once the electrode and the cannula are positioned in the retrogasserian portion of the trigeminal nerve with a standardized technique, manipulation of the electrode about its 360° axis readily enables an infinite variety of position adjustments of the electrode tip. This capability enables easier and more precise electrode placement and lesion production. Undesirable lesions of the motor root may be avoided. A curved electrode has been used in 150 patients. The incidence of masseter weakness is 7.3% in this series, compared to 24% in our series of 700 patients treated with a straight electrode. The incidence of undesirable paresthesias has decreased from 27% to 10.6%. The immediate results obtained in patients with the curved electrode have improved. Excellent results (no pain, no side effects) have been achieved in 88% of patients, in contrast to 76% treated with the straight electrode. Application of stereotactic principles and the use of the curved electrode have enhanced the appeal of PSR for the treatment of trigeminal neuralgia.

scholarly journals TRIGEMINAL NEURALGIA AND ITS RECENT ADVANCES

2020 ◽  
pp. 1-4
Author(s):  
R. Nithyanand
Keyword(s):  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Sodium Channel ◽  
Clinical Investigation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Options ◽  
Gasserian Ganglion ◽  
Recent Advances ◽  
The 1960S ◽  
The Individual

Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Nav1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.

Trigeminal Neuralgia: Role of Interventional Pain Physician

2019 ◽  
Vol 11 (1) ◽  
pp. 73-77
Author(s):  
Chandra Shekhar Karmakar ◽  
Md Lutfor Rahman ◽  
Md Shahidul Islam ◽  
Atidh Muhammad Molla ◽  
Monirul Islam ◽  
...  
Keyword(s):  
Trigeminal Neuralgia ◽  
Trigeminal Nerve ◽  
Treatment Options ◽  
Vascular Compression ◽  
Gasserian Ganglion ◽  
Invasive Treatment ◽  
Provide Pain Relief ◽  
Lancinating Pain ◽  
Glycerol Rhizolysis ◽  
Neural Discharge

Trigeminal neuralgia (TN) or tic douloureux is one of the commonest cause of fascial pain after 50 years of age. It is characterized by recurrent, episodic, lancinating pain over the distribution of trigeminal nerve. There is a lack of certainty regarding the aetiology and pathophysiology of TN. Evidence suggests that the likely etiology is vascular compression of the trigeminal nerve leading to focal demyelination and aberrant neural discharge. Secondary causes such as multiple sclerosis or brain tumors can also produce symptomatic TN. The treatment of TN can be very challenging despite the numerous options patients and physicians can choose from. This multitude of treatment options poses the question as to which treatment fits which patient best. For patients refractory to medical therapy, Gasserian ganglion percutaneous techniques, gamma knife surgery and microvascular decompression are the most promising invasive treatment options. Among them three common interventions commonly carried out by interventional pain physician to provide pain relief are balloon compression, Glycerol rhizolysis and RF rhizotomy. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 73-77

Trigeminal neuralgia caused by a trigeminocerebellar artery

2014 ◽  
Vol 121 (4) ◽  
pp. 940-943 ◽  
Author(s):  
Kenichi Amagasaki ◽  
Shoko Abe ◽  
Saiko Watanabe ◽  
Kazuaki Naemura ◽  
Hiroshi Nakaguchi
Keyword(s):  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Trigeminal Nerve ◽  
Basilar Artery ◽  
Nerve Root ◽  
Trigeminal Nerve Root ◽  
Offending Artery ◽  
The Right

This 31-year-old woman presented with typical right trigeminal neuralgia caused by a trigeminocerebellar artery, manifesting as pain uncontrollable with medical treatment. Preoperative neuroimaging studies demonstrated that the offending artery had almost encircled the right trigeminal nerve. This finding was confirmed intraoperatively, and decompression was completed. The neuralgia resolved after the surgery; the patient had slight transient hypesthesia, which fully resolved within the 1st month after surgery. The neuroimaging and intraoperative findings showed that the offending artery directly branched from the upper part of the basilar artery and, after encircling and supplying tiny branches to the nerve root, maintained its diameter and coursed toward the rostral direction of the cerebellum, which indicated that the artery supplied both the trigeminal nerve and the cerebellum. The offending artery was identified as the trigeminocerebellar artery. This case of trigeminal neuralgia caused by a trigeminocerebellar artery indicates that this variant is important for a better understanding of the vasculature of the trigeminal nerve root.

scholarly journals Recent advances in understanding/managing trigeminal neuralgia

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 505 ◽  
Author(s):  
Mark Obermann
Keyword(s):  
Trigeminal Neuralgia ◽  
Medical Treatment ◽  
Sodium Channel ◽  
Clinical Investigation ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Treatment Options ◽  
Gasserian Ganglion ◽  
Recent Advances ◽  
The 1960S ◽  
The Individual

Despite recent advances in understanding and treating trigeminal neuralgia, its management remains a considerable challenge. Better classification of different types of facial pain and the identification of prognostic factors for different treatment options lead the way toward better quality of life for the individual patient. Although the principles of treating trigeminal neuralgia remain basically the same, antiepileptic drugs, muscle relaxants, and neuroleptic agents are widely used medical treatment options. They were not originally developed for treating trigeminal neuralgia. Carbamazepine was studied in adequate placebo-controlled clinical trials in the 1960s and is still considered the most effective drug. Among emerging treatment options currently under clinical investigation are local botulinum neurotoxin type A injections and a novel sodium channel blocker (CNV1014802) that selectively blocks the Nav1.7 sodium channel. Non-pharmacological treatment options are non-invasive electrical stimulation with either transcranial direct-current stimulation or repetitive transcranial magnetic stimulation which both require further evaluation in regard to applicability. Surgical options remain a valid choice for patients not responding to medical treatment and include Gasserian ganglion percutaneous techniques, gamma knife surgery, and microvascular decompression. There is continual effort to improve these techniques and predict the outcome for better patient selection.

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